Maisie Carrillo
San Antonio,TX
Summary
Proven Quality Assurance Analyst with a track record of enhancing documentation accuracy for QTC Management by leveraging exceptional attention to detail and bilingual communication skills. Expert in QA planning and data scrubbing, significantly improving report clarity and compliance. Demonstrates creative problem-solving and thoroughness, ensuring top-notch customer service and operational efficiency.
Overview
13
13
years of professional experience
Work History
Quality Assurance Analyst
QTC Management
San Antonio
08 2023 - Current
- Work closely with medical providers and the Veterans Administration to ensure the documentation is complete and accurate
- Review documentation sent over from medical providers and ensure that the report is complete, concise, clear and correct and the provider the provider has completed the questionaire for the Disability Benefit for delivery back to the VA.
- Ensure that all diagnostics have been returned and entered in to document.
- Ensure all medical coding is complete and accurate.
- Work with in house appointment scheduled to request additional appointments if necessary.
- Coordinate with medical providers as needed for clarification on reports
Case Specialist
QTC Management
San Antonio, TX
11.2022 - 08.2023
- Conduct high-volume outbound calls.
- Deliever exceptional customer service to ER patients
- Triage daily download of referrals and ensure appropriate worksheets are assigned to corresponding conditions
- Verify that CPT and CLIN codes are assigned to each case.
- Schedule appointments for examines, including follow-up appointments, and reschedule appointments.
- Investigated alternative solutions for difficult cases while maintaining confidentiality.
- Ensure all examinees and providers receive necessary documentation.
- Reviewed and processed case files for accuracy and completeness.
Insurance Verification Specialist
STARS plastic surgery
San Antonio, TX
01.2020 - 11.2022
- Reviewed medical records to ensure accuracy of required information needed for pre-authorization requests.
- Verified patient eligibility for insurance coverage by contacting insurance carriers and obtaining the necessary authorization numbers.
- Assisted in resolving claim issues related to billing and reimbursement inquiries.
- Identified discrepancies in patient's insurance coverage or benefits, ensuring accuracy of data entered into system.
- Collaborated with internal staff members such as Billing Specialists, Medical Coders., to resolve any discrepancies in patient's insurance information.
ER Registrar
Southwest General
San Antonio, TX
06.2019 - 01.2020
- Provided assistance to patients in completing necessary forms for admission.
- Processed payments, collected co-payments and deposits from patients.
- Assessed coding accuracy, using ICD-10 codes, CPT codes, HCPCS codes, and modifiers.
- Quickly responded to staff and client inquiries regarding CPT codes.
ER Registrar
Methodist Hospital
San Antonio, TX
06.2013 - 02.2018
- Answered patient questions regarding registration and insurance processes.
- Researched coding updates from national organizations such as ICD-10, CPT and HCPCS codes.
- Developed a comprehensive understanding of the ICD-9 and 10 and CPT coding systems.
- Performed quality assurance reviews of CPT and ICD-10 codes assigned by coders.
Insurance Verification Specialist
Gasterenterology of San antonio
San Antonio, TX
02.2012 - 06.2013
- Reviewed medical records to ensure accuracy of required information needed for pre-authorization requests.
- Verified patient eligibility for insurance coverage by contacting insurance carriers and obtaining the necessary authorization numbers.
- Developed a working knowledge of insurance plans, including Medicare and Medicaid regulations and requirements.
- Assisted in resolving claim issues related to billing and reimbursement inquiries.
- Identified discrepancies in patient's insurance coverage or benefits, ensuring accuracy of data entered into system.
Education
Galen College of Nursing
San AntonioSkills
- Exceptional communication skills
- attention to detail
- quality customer service
- Bilingual communication
- Data scrubbing
- Creative problem -solving
- time management
- ability to work independently or in a team enviornment
- QA planning
- Thoroughness in Review
Languages
spanish
Native/ Bilingual
Timeline
Case Specialist
QTC Management
11.2022 - 08.2023
Insurance Verification Specialist
STARS plastic surgery
01.2020 - 11.2022
ER Registrar
Southwest General
06.2019 - 01.2020
ER Registrar
Methodist Hospital
06.2013 - 02.2018
Insurance Verification Specialist
Gasterenterology of San antonio
02.2012 - 06.2013
Quality Assurance Analyst
QTC Management
08 2023 - Current
Galen College of Nursing
Similar Profiles
Terence GossTerence Goss
Medical Assistant at QTC ManagementMedical Assistant at QTC Management
Angel GuevarezAngel Guevarez
Quality Assurance Specialist at QTC ManagementQuality Assurance Specialist at QTC Management
Kelsie CollinsKelsie Collins
Quality Assurance Analyst at QTC ManagementQuality Assurance Analyst at QTC Management